The state Assembly approved on Wednesday evening a billthat would create a single-payer health system in New York.

The bill passed 89-47.

As my colleague Claire Hughes reported this morning, the vote is the first to occur on the proposal, which Health Committee Chair Richard Gottfried has introduced annually for years, since 1992.

“New Yorkers deserve better,” Gottfried said in a statement. “We should be able to go to the doctor when we need to, without worrying whether we can afford it. We should choose our doctors and hospitals without worrying about network restrictions. We deserve health coverage for all of us, paid for based on our ability to pay, not what the market will bear. I’m proud the Assembly has passed the New York Health Act, and I look forward to working with a great community of advocates including medical professionals, medical students, organized labor, and Senate sponsor Bill Perkins, to enact it into law.”

More from Claire Hughes:

"The proposal, called the New York Health Act and dubbed “Medicare for all” by advocates, would provide comprehensive health coverage to all New Yorkers.

With 82 co-sponsors, the bill has a superb chance of getting the 76 votes it needs to pass the Democratic-controlled Assembly. (Passage is highly unlikely, however, in the Republican-majority state Senate.)

Some medical groups and labor unions have supported the proposal in recent years, in addition to grassroots proponents. They argue that a single-payer system would be less costly and easier to administer than the current private health system.

The Health Plan Association, which represents insurance companies, has opposed it; its CEO, Paul Macielak, said at an Assembly hearing in January that the act would dissolve the current private health care industry, which has a proven record for providing care.

Since a public option that would run parallel to a private insurance system failed to make it into the federal law known as Obamacare five years ago, advocates for a single-payer health system have focused their work on the states.

The failure of the federal law known as Obamacare to include even a public option that would run parallel to a private insurance system moved the focus of the single-payer movement to the states.

Vermont recently backed away from implementing a single-payer plan due to the high cost. An analysis released in March by a University of Massachusetts professor estimated New York health care expenditures would actually be reduced by $45 billion a year if the law were enacted.

]]>Healthcare Human RightThu, 28 May 2015 00:00:00 -0400Former Rep. Allyson Schwartz's new group, The Better Medicare Alliance, is not what it appearshttp://www.pdamerica.org/component/k2/item/549-former-rep-allyson-schwartz-s-new-group-the-better-medicare-alliance-is-not-what-it-appears
http://www.pdamerica.org/component/k2/item/549-former-rep-allyson-schwartz-s-new-group-the-better-medicare-alliance-is-not-what-it-appears

Commentary: Fronting for a phony front group

The health insurance industry took advantage of Washington’s infamous revolving door last week when it named former Rep. Allyson Schwartz of Pennsylvania, perceived by many to be a liberal Democrat, as the face of its latest K Street-operated front group.

Schwartz, a former five-term member of Congress who made an unsuccessful bid for Pennsylvania governor last year, announced in an email blast Tuesday that she had found work again, not back home but back inside the Beltway. “Today I will begin as President and CEO of the Better Medicare Alliance,” she told her “friends and supporters.”

The Better Medicare Alliance is a so-called 501(c)(3) nonprofit that appears to have been created with funding from insurance companies by APCO Worldwide, a Washington influence firm with a long history of running front groups for its clients. I worked with APCO on several projects during my years at Cigna.

The Better Medicare Alliance’s raison d’etre is to widen the federal spigot of taxpayer dollars already gushing into the bank accounts of insurance companies that operate Medicare Advantage plans, those privately run alternatives to traditional Medicare. Enrollment is concentrated in a small number of companies, among the biggest of which are for-profit insurers UnitedHealth Group, Humana and Aetna.

As the Center for Public Integrity has reported extensively over the past year,the federal government for years has overpaid Medicare Advantage insurers, which has enabled the companies to better reward their shareholders. Insurance firms have also used the overpayments to add benefits not covered by traditional Medicare, like hearing aids, and to offer lower copayments.

Insurers that participate in the Medicare Advantage program devote big chunks of their advertising and sales budgets to lure seniors away from the traditional Medicare program, which costs taxpayers less. For many seniors, the marketing is irresistible. Enrollment in Medicare Advantage plans jumped 10 percent between 2013 and 2014. Thirty percent of Medicare’s 54 million beneficiaries are now in a Medicare Advantage plan.

Insurers insist that Medicare Advantage plans represent a good value for seniors and the country. They say, for example, that because of the managed care techniques they use, they are better able to coordinate care for seniors with chronic conditions.

A downside rarely mentioned is that many doctors and health care facilities, including nursing homes, refuse to participate in Medicare Advantage provider networks. Other providers that might want to participate are often excluded. My own mother didn’t fully appreciate the consequences of her Medicare Advantage plan’s limited network until recently. She decided to switch back to traditional Medicare so she could go to a nursing home of her choice with high quality ratings.

“The purpose of the Better Medicare Alliance is to bring together a national coalition of health plans, providers, advocates and beneficiaries to support and strengthen Medicare Advantage,” wrote Schwartz. Despite being a favorite of Emily’s List and other liberal groups, Schwartz received a third of the $16 million she raised in campaign contributions during her career from people and companies in health care and insurance and from “lawyers and lobbyists,” according to OpenSecrets.org.

Having worked with numerous front groups in the past, I’m betting that the real purpose of the Better Medicare Alliance is to strengthen the profits of health insurers, many of whom contributed to her various campaigns, by making sure that proposed cuts to Medicare Advantage plans never get implemented.

Even though the Better Medicare Alliance lists several nonprofit organizations as allies on its website (and gives them equal billing to Aetna, Humana and UnitedHealth Group), I recognized many of them—the U.S. Chamber of Commerce, the National Association of Manufacturers, the National Retail Federation and the Healthcare Leadership Council—as groups ever ready to aid and abet the insurance industry.

As an industry executive, I worked with every one of them during the various campaigns we waged whenever a proposed law or regulation surfaced somewhere that might have hurt profits. Know this, though: while those organizations were willing to lend their names to give our front groups the appearance of being genuine coalitions, they expected us to kick in most if not all of the money to cover the front groups’ expenses.

So how can I be so sure the Better Medicare Alliance is a front group, aside from the mention of the usual suspects as allies? There are these other tell-tale signs: no listing of a physical address or phone number on its website; no mention of employees other than Schwartz; no board of directors (I wanted to know who actually hired Schwartz and who she answers to); no apparent way to reach anyone there other than through a generic email address. (The questions I submitted to the group last Wednesday have still not been answered.)

I did finally find the name of a real person, someone I had worked with often during my days in the industry, not on the group’s website but on its press releases. He’s Bill Pierce. Senior Director of, you guessed it, APCO Worldwide.

Liz Nikazmerad is a rarity in American labor: a local union president under the age of 30, displaying both youth and militancy. For the last two year years, she has led the 180-member Local 203 of the United Electrical Workers (UE), while working in the produce department of City Market in Burlington, Vermont. Thanks to their contract bargaining, full-time and part-time employees of this bustling community-owned food cooperative currently enjoy good medical benefits.

But that wasn’t always the case in Nikazmerad’s past non-union jobs, nor is it any assurance that UE members won’t be forced to pay more for their health care in the future. To curb medical cost inflation and related cost-shifting to workers, the UE has long advocated that private insurance plans be replaced with publicly funded universal coverage.

Four years ago, a newly elected Vermont governor, Peter Shumlin, took a promising first step in that direction at the state level. His Democrat-dominated legislature passed Act 48, which laid the groundwork for creating a comprehensive public insurance plan called Green Mountain Care (GMC).

Not all activists deemed GMC to be truly “single-payer,” because of potential legal or political obstacles to the inclusion of Vermonters currently covered through Medicare, the Veterans’ Administration, and even some “self-insured” plans offered by local employers. However, Act 48’s blueprint for getting everyone else into a more rational, cost-effective healthcare system, financed by taxes, was generally hailed as a great breakthrough.

Unfortunately, the Affordable Care Act (ACA) first required Vermont to operate a private insurance exchange until 2017, when a federal waiver permitting further experimentation might be granted. Despite this delay, Shumlin was still reassuring Vermonters, as recently as last fall, that a brighter health care future lay just a few years ahead.

By January 8, when the governor began his third term, that promise had dimmed so much that Liz Nikazmerad and several hundred others weren’t there to applaud his inauguration in Montpelier. Instead, frustrated advocates of health care reform staged a sit-in at the state capitol, chanting and singing, unfurling banners and refused to leave in protest against the governor’s abrupt abandonment of universal health care six weeks after his re-election.

“People had fought for this a long time,” Nikazmerad says. “It was a huge win and to have the rug yanked out like that was very upsetting. People were very emotional about it.”

Escalating labor protests

By the end of day, the UE leader and 28 others—now known as “The Statehouse 29”—faced multiple criminal charges, including resisting arrest, despite the peaceful nature of their capitol sit-in. The cases against 18 were later dropped; other participants settled by paying a fine or promising to do community service work. Their still controversial reproach to the governor has, since January, become the first in a series of angry labor sorties to Montpelier.

During the current legislative session, the bitter recriminations over the governor’s health care retreat have morphed into broader controversies about workers rights, contract concessions, and what the Vermont Progressive Party (VPP) calls Shumlin’s “austerity budget.” On April 11, 500 state employees, school teachers and other union members rallied at the state house to protest threatened budget cuts and state worker lay-offs. Among the demonstration sponsors were the VPP, the Vermont State Employees Association (VSEA), and the Vermont Workers Center, which is also building for another big labor gathering on May Day in Montpelier.

“I’m tired of being asked to give back more and more of my wages and benefits, “ state highway department plow driver Ed Olsen told the crowd. “The state always wants to balance the budget on the backs of hard-working Vermonters.”

Alison Sylvester, a leader of the Vermont NEA, added her union’s voice to the “Fight Back” rally and hailed public teachers successful defense of their right to strike. After a brief public school work stoppage in South Burlington last fall, Governor Shumlin publicly endorsed the idea of banning such strikes, which have been legal in Vermont for fifty years. It took several months of frantic lobbying by hundreds of teachers to kill this idea, by a two-to-one margin, in a Vermont House vote in early April.

About-face on single payer

Shumlin’s most publicized betrayal of past labor allies occurred, with little advance notice, on December 17. That’s when he called a press conference and declared that “now is not the time to ask our legislature to take the step of passing a financing plan for Green Mountain Care.” The 58-year old governor, a multi-millionaire former business owner, had already postponed the day of reckoning on how to fund universal coverage for more than two years, until he was narrowly elected for the third time. (In last year’s gubernatorial race, Shumlin greatly outspent his Republican challenger, but won by only 2,500 votes; his 46 percent showing would not have been sufficient without conservative vote-splitting by a Libertarian candidate.)

The 2015 session of the legislature was expected to take up the challenge of Act 48 financing in January. With the acquiescence of key legislators, Shumlin short-circuited that debate by issuing a highly unfavorable status report of his own, which seemed to validate past single-payer criticism by the Vermont GOP and conservative Democrats. According to Shumlin, the latest projected cost of universal coverage would double the state budget in its first year alone, while requiring onerous new payroll and income taxes.

“In my judgment,” the governor stated, “the potential economic disruption and risks would be too great to small businesses, working families, and the state’s economy.”

The VWC, which helped mobilize statewide support for passage of Act 48 four years ago, countered the governor’s claims by releasing its own plan for financing Green Mountain Care in a manner more equitable than the state’s current market-based system.

One hundred economists endorsed the VWC approach, which relies on progressive taxation. The VWC also struck back with a clever “whiteboard” video, entitled “The Time is Now: Healthcare Financing for Vermont, Explained in Three Minutes.” But, of course, neither that quick tutorial on health care reform math or the VWC’s full report garnered the media attention—or had the same legislative clout—as Shumlin’s self-demolition of Green Mountain Care.

From bad to worse in Montpelier

In his state budget address in January, Shumlin had another surprise for his past labor friends. He presented the 5,500-member VSEA with a choice between re-opening its current contract and agreeing to give-backs or face hundreds of layoffs. These steps were necessary, he announced, to close a fiscal year 2016 budget deficit, projected to be $112 million, which soon become the main preoccupation of his administration and its legislative allies.

Legislators representing the Vermont Progressive Party (VPP), the nation’s most successful third party formation, urged their Democratic colleagues to raise needed revenue by capping tax deductions for the wealthiest Vermonters and taxing capital gains on the same basis as earned income.

Neither the Democratic leadership nor the governor wanted to do that. So his administration is instead seeking $8.8 million in state worker concessions, and the Democrat-controlled House has already approved cuts in social programs like heating assistance for low-income households.

In 2008-9, VSEA members agreed to a 3% pay cut, followed by a freeze, under Shumlin’s Republican predecessor. When Shumlin ran for governor in 2010, he promised to be more labor-friendly and find better ways to pay for state programs, including the projected single-payer-like plan. Now he is scapegoating unions that backed him and health care reform, complaining that state workers’ scheduled pay hike this year is unreasonably high. “There aren’t too many Vermonters who are getting a 5% increase this year,” he told the press on April 11.

Shumlin’s about-face on Green Mountain Care reflected more than revised estimates of its cost and feasibility. The troubled 2013 rollout of Vermont Health Connect, the state’s ACA-mandated private insurance exchange, adversely affected public perceptions of the longer-term goal of single payer. Among those most upset were lower-income people previously covered by state-subsidized plans who ended up paying more out-of-pocket when insured through the new exchange.

“Over the last few years, the Shumlin administration hasn’t done anything to give Vermonters confidence that we could handle being innovators in health care,” says Chris Pearson, a Progressive state rep and vice-chair of the House Committee on Health Care. “There were just too many bad headlines about the nightmare of enrolling, computer problems and cost over-runs.”

As a result, the popularity of Green Mountain Care is not what it was even a year ago. Pollsters working for the Vermont NEA found 55 percent of those surveyed in favor of the concept then, while 42 percent were opposed. A slight majority remained in favor even if implementation required, as it would, a large tax increase to capture health care system revenue currently coming, in myriad forms, from individuals and employers, in both the private and public sector.

After the recent flurry of negative publicity about Green Mountain Care—much of it generated by Shumlin’s own disputed cost estimates— 64-percent of Vermonters polled in February said they supported the governor’s new position, only 20 percent were opposed, and 10 percent were unsure. Even a majority of Democrats polled said they favored his abandonment of single payer, for the time being.

Inside the state legislature, friends of Act 48 still hope to emerge from this legislative session with an authorized study of the VWC’s financing plan, the governor’s contested findings and a publicly funded primary care plan that has been proposed by some single payer advocates as an incremental step toward Green Mountain Care.

Organizing Challenges Ahead

Sometime in May, the legislative wrangling in Montpelier over budget cuts, health care, and workers rights will be over for this year. But the challenges facing Vermont Progressives and labor-community organizers will remain daunting. Chief among them is sustaining a now seven-year-old campaign to make “healthcare a human right” after such a demoralizing setback. While continuing to assist private and public sector workers involved in strikes and contract fights, the Vermont Workers Center plans to do more grassroots organizing around the shortcomings of Vermont Health Connect coverage.

Within the VPP, its statewide organizer Kelly Mangan has “gotten a lot of member feedback about running a candidate for governor next year.” This is something her third party refrained from doing in the last three election cycles, to avoid putting a Republican in office—who would have opposed Act 48 from the outset or shelved it sooner than Shumlin did.

Now, the growing estrangement of labor voters from the Democrats could lead to Shumlin’s replacement by a Republican. One likely candidate for the job is Lieutenant Governor Phil Scott, the affable GOP incumbent who defeated Vermont Progressive Party (VPP) candidate Dean Corren last November by a 62 to 34% margin, with no Democrat on the ballot.

Any backlash against Vermont Democrats next year, though, might be salved by further VPP legislative gains. Last fall, seven Progressive state reps and three senators were elected, creating the VPP’s largest delegation in Montpelier ever. In March, Progressives captured four seats on the Burlington City Council, where the VPP has jousted with a centrist Democrat mayor.

But, next year, personal health problems may prevent state senator Anthony Pollina, the VPP’s most experienced statewide standard-bearer, from running for governor. (In 2008, he placed second in a three-way race). At the moment, Vermont’s most successful progressive politician, U.S. SenatorBernie Sanders, seems more intent on seeking executive office higher than any available in Montpelier, where, as governor, he could help get Vermont back on the single-payer road.

In his not-yet-official campaigning for the White House, Sanders speaks regularly to out-of-state audiences about the need for a “political revolution.” Unfortunately, on his own home turf, the wrong kind of revolution may be brewing, fed by working class alienation from pro-corporate Democrats.

STEVE EARLY

Steve Early worked for 27 years as an organizer and international representative for the Communications Workers of America. He is the author of a new book from Monthly Review Press titled, Save Our Unions: Dispatches from a Movement in Distress. He is working on a book about political change and public policy innovation in Richmond, California. He can be reached at Lsupport@aol.com

More than 100 economic professors from across our country have signed on to a letter, calling for Vermont Gov. Peter Shumlin and that state's legislature to enact universal health care in the Green Mountain State.

Vermont has had plans to implement a universal health care system in that state for some time now, but Gov. Shumlin put those plans on hold late last year, after concerns came up over how the system would be paid for.

In the letter to Shumlin, the professors argue that health care should be provided as a public good, and that financing it actually helps to save money in the long run.

The professors write in part that, "Evidence from around the world demonstrates that publicly financed health care systems result in improved health outcomes, lower costs and greater equity. Public financing is not a matter of raising new money, but of distributing existing payments more equitably and efficiently."

While the professors make a great point, the fact is that Vermont gave universal health care a great shot. That state tried hard to make it work, and did its best to bring health care to all Vermonters.

But Vermont is a very small state, with a population of just over 626,000 people. And, in a state that small, implementing universal health care is a very hard thing to do.

For universal health care to really be successful, it needs to be done at a national level.

Fortunately, the US already has the framework in place to make universal health care a success. That framework is called Medicare.

A lot of people forget this but, back in July of 1965 when Medicare was established by Congress, it was established with the idea that one day it would be slightly changed to become THE national single-payer health insurance program for the US.

Well, the day to make those changes is now.

Currently, Medicare is made up of four parts: Part A which covers hospital stays, Part B with pays for medical services, Part C which pays for private insurance coverage, and Part D with pays for prescription drugs.

Now, it's time to create "Medicare Part E," which would cover every single American. Just let any citizen in the US buy into Medicare.

Best of all, creating "Medicare Part E" would be really easy. It wouldn't be some complicated process that requires Congress and the government to re-invent the wheel.

All Congress would have to do is pass a simple bill that says any American can buy into Medicare at a rate predetermined by the Centers for Medicare and Medicaid Services and the Department of Health and Human Services.

In would also be pretty easy to get Americans enrolled in universal health care and "Medicare Part E."

Basically, as soon as legislation is passed approving "Medicare Part E," the government would begin lowering the eligibility age for Medicare.

Each year, the eligibility age would drop by a decade, letting around 30 million new Americans into the program.

This process would be repeated each year, and within seven years, all Americans are covered by Medicare.

Of course, like with any idea, "Medicare Part E" has its opponents. There are people who just won't want to be part of it.

Luckily for them, they would still be able to buy private health insurance, and hand over their hard-earned money to billionaire insurance executives.

My daughter, Kate, was born at Johns Hopkins hospital in 1994. I had a private room for three days. Most mothers are sent home after a day, even if the baby is required to remain in the hospital. Kate was low birth weight, and a bit jaundiced. The doctors wanted to keep here there, so they found a way to keep me there. It cost me something like $27. For everything, all the pre-natal care, labor and delivery. Everything. My husband was in the army and his benefits covered all of it. I don’t recall even filling out any forms.

Kate was a healthy, happy baby and toddler. But there were a few scares over the first few years. Pneumonia and lazy eye early on. Later, tonsils and adenoids had to come out. These were mostly routine concerns, and all of them were diagnosed and taken care of immediately. Then the axe fell.

In 1999, when Kate was in kindergarten, my husband was posted to Hawaii. During Thanksgiving vacation, my parents, her grandmother and grandfather, visited for the first time. Although she’d been excited to see them, she was just not herself. She was tired, lethargic and had no appetite. When there was no improvement, we took her to the doctor. He thought she had a sinus infection and put her on antibiotics. But it didn’t do any good.

By the second week of December, my parents had gone home, assuming that there was nothing seriously wrong with their granddaughter. But there was still no improvement. Kate didn’t want to see Santa at a staff party at Fort Shafter, so we went back to the doctor. While in the waiting room, sitting in my lap with her head listlessly against my shoulder, someone came out and clapped an oxygen sensor on Kate’s finger, took a reading and left abruptly. She returned with urgency and placed an oxygen mask over Kate’s face. She then had a chest x-ray, after which we were told to take her to the ER at Tripler Army Medical Center without delay. After extensive blood work, several doctors came in and the curtain was closed. Our daughter had ALL, acute lymphoblastic leukemia, and it was very bad.

A liter and a half of fluid was drained from her lungs, and a massive program of chemotherapy begun immediately. There was a laundry list of drugs, whose odd scary names I will never forget. Vincristine, doxorubicin, mercaptopurine, prednisone, methotrexate, L-asparaginase, zinecard.

Kate was transferred from Tripler to Kapiolani, a women’s and children’s hospital, so she could have immediate kidney dialysis. She was in the number one bed in the ICU, closest to the nurses’ station, which was reserved for the most critical patient in the room. We were told that she had a non-functioning immune system, and her electrolyte levels were “incompatible with life.” After forty-eight hours, she returned to Tripler.

We were terrified. Kate was dying. Her oncologist told us that she was the sickest patient he’d ever had at the point of diagnosis. Children usually just don’t walk in the door looking that bad. If we had come in even one day later, or if treatment had been delayed by twenty-four hours, her heart would’ve stopped or she’d no longer be able to breathe. Kate would’ve been dead.

There are established protocols of treatment for ALL. Very quickly, we were handed a folder; a roadmap of her expected treatments over the next two years. This began with weekly IV’s for chemotherapy and blood work, which lasted six months. The visits became monthly, and then quarterly. Kate took pills every single day for two years. At one point, I dropped an entire bottle of Zofran, prescribed to control nausea, into the toilet. Without hesitation, I called the doctor, who told me to just come in and get an immediate re-fill. I later learned that Zofran retails for $70 a tablet. At fifteen to twenty pills a bottle, this was an enormous amount of money down the drain. But the cost was neither mentioned nor an issue.

Kate spent twelve days in the hospital and then came home. She endured 105 weeks of treatment. She had cranial radiation. Her long beautiful honey blond hair fell out. She vomited after every trip to the hospital and lost weight. Her face puffed up from steroids, which also made her restless and cranky. She endured a series of spinal taps, and had an external catheter implanted in her shoulder. She missed school and suffered mild brain damage, resulting in some fuzzy and frustrating learning disabilities.

But she survived. She was cured. Childhood leukemia is the cancer you want your kid to have. It’s the one with the highest survival rate, over 80%.

As traumatic and nightmarish as all this was, we were spared one fundamental aspect of having to face a life threatening disease. We did NOT have to fight an insurance company every step of the way. We didn’t have to fill out dozens of forms, or get company approval for every medical decision. Her treatment wasn’t determined by cost or whether a doctor was in or out of a network.

Kate had the most excellent care imaginable. Her doctors were wonderful, even providing me with their home phone numbers. I can’t imagine what would have happened if we’d had to figure out where to go or how to pay for it. She was five years old and dying. I didn’t have any prior understanding of the treatments or options, and I didn’t have the time or energy to research them. I slept in a chair in the hospital for two weeks, only going home occasionally to shower and change clothes.

Our military health coverage allowed me to be a mother and her doctors to make decisions based on her immediate needs, not how much a procedure cost as compared to whether it might be effective.

I have no doubt that she’s alive now because of that health coverage. I don’t know the details of the Affordable Care Act. But I do know that everyone in this county needs, and should have, what my family had. The simple, complete, easily accessible and effective coverage that saved my daughter’s life. If this is a single payer system, and that’s the best alternative, then isn’t that what we should have?

Claire Surovell works for a bank in NYC, and is no longer entitled to military benefits. Kate retains them until age twenty-one, along with commissary privileges. After that, she can keep them only by paying an additional monthly premium.

The Republican-led House of Representatives just unsuccessfully attempted to undo the Affordable Care Act for the 56th time.
While it's been well established that repealing Obamacare without a plausible replacement would leave tens of millions of people uninsured and worsen our deficits by accelerating the growth in healthcare costs, it's also important to note that this continued GOP crusade to get government out of health care runs directly counter to the stated will of the majority of Americans.

A new poll shows that more than half of Americans -- including 80 percent of Democrats and a quarter of Republicans -- support expanding health reform to "Medicare for All." While Obamacare has been a step in the right direction, more and more people across the country understand that a single-payer healthcare system is the only way to guarantee quality care and at the same time reduce medical costs.

The United States spends almost twice as much per person on health care as any other country, yet our key outcomes -- life expectancy, infant mortality and preventable deaths -- too often lag behind our peers. A recent Commonwealth Fund study ranked the U.S. healthcare system dead last among 11 highly developed countries in terms of quality, efficiency and access to health care.

What are we doing wrong?

One major problem is that billing and insurance-related administrative costs -- in other words, bureaucratic red tape -- cost the American people $471 billion in 2012. That's enough money to pay for our country's whole interstate highway system. At least 80 percent of that extraordinary cost was, according to a respected study, due to inefficiencies in our for-profit, multipayer healthcare system.

By adopting a "Medicare for All" model -- which, by the way, is the standard for health care throughout the industrialized world -- we can achieve hundreds of billions of dollars in cost savings that can be used to cover the nation's remaining uninsured and upgrade coverage for millions of underinsured citizens. While the ACA has brought insurance to 19 million Americans, 13 percent still lack health insurance, including one out of every five young adults. Notwithstanding the fact that the ACA has significantly reduced out-of-pocket costs, 21 percent of insured Americans are still spending 5 percent or more of their income on out-of-pocket costs.

This week I was joined by 44 members of Congress in reintroducing the only healthcare legislation that will overcome these persistent challenges to our healthcare system: H.R. 676, or "The Expanded and Improved Medicare for All Act." This bill has been introduced in every Congress since 2003 and has a broad base of support among healthcare activists, organized labor, physicians, nurses, and social-justice organizations across the nation. The bill has been endorsed by 26 international unions, Physicians for a National Health Program, two former editors of the New England Journal of Medicine, National Nurses United, the American Medical Students Association, Progressive Democrats of America, the NAACP, and countless others.

This isn't just good ethics; it's also good economics. H.R. 676 will boost the economy by enabling America's small businesses to focus on building their companies rather than on dealing with the cost and complexity of providing healthcare for their employees. H.R. 676 keeps the delivery of health care a private matter, enabling health providers to engage in market-based competition and innovation.

Half a century ago, addressing the convention of the Medical Committee for Human Rights, Martin Luther King Jr. declared, "Of all the forms of inequality, injustice in health care is the most shocking and inhumane." It's time to adopt a serious comprehensive plan to address it.

Joel Segal's Real World Comment On: “The Long Term/Home Care Crisis In America: Why We Need Expanded And Improved Medicare For All, HR 676, And One Unified Populist Movement To Pass the Bill”

*(Authors Note: In my last article, I did not clarify that my Congressional Insurance Plan Co-Pays Are $800 Per Month For The Next 6 Months; not $800 per year. :)

Today, my 84 year old wonderful mother was released from the Tamarac Rehabilitation Center in Sunrise, Florida after undergoing double bi-pass heart surgery. She is lucky to be alive: 99% of her arteries were blocked.

But, what is both shocking and immoral, is that her Medicare HMO will only cover two nursing visits per week, even though she needs emergency assistance every day, right now, with walking, cooking, bathing, eating and cleaning. I am very blessed and fortunate to be able to take of my mother for a few weeks, because I have a job that allows me to work at her home for a period of time via computer.

So the following question must then be asked: What would happen if I was not able to take care of my 84 year old mother after her surgery? How would she be able to walk, bathe, or eat? Why does my Mother’s Medicare HMO plan only cover two daily nurse visits per week, knowing that my mother is 84, and just had major heart surgery? Seems a little unfair, if not a human rights violation, which is what corporate health care is---a human rights violation against America.

Any civilized nation should have a health care system where there is quality, affordable, and accessible home health care services for all of our nation’s seniors. If we had a national health insurance program, as proposed in Rep. Conyer’s HR 676, we would be able to save approximately $350 billion dollars per year, and use a portion of this savings to invest in the training and hiring of more nurses, who could provide much needed home health care services for our nation’s senior citizens. Just think about how many struggling unemployed men and women could be hired to take care of our senior citizens and the disabled in their own homes?

We can transition to a “caring society,” and pass legislation like HR 676, only if progressive communities in America unite under one diverse, multi-issue, and multi-racial umbrella network, and cooperate with one another--- so we can truly fight for the people. We must examine how we can obtain real on the ground electoral and political power, so that we can create a more caring and loving society in America; one that cares more about people than profits and consumption.

Joel Segal is the former senior legislative assistant and speech writer for Rep. John Conyers, co-author of HR 676, and a Board member of “People Demanding Action,” a new network of citizens across the country working for jobs, peace, and justice.

Hours before Christmas, at exactly 7:00am on December 24th, I was heading to the Emergency Room at Montefiore Medical Center in the Bronx. Montefiore is one of the largest hospitals and medical teaching institutions in the country and closely associated with the prestigious Albert Einstein College of Medicine - a city within a city with a staff of over 20,000 and a hospital bed capacity of nearly 2,000. "Monte" also has additional facilities in New Rochelle and Mount Vernon in Westchester County, while its main facility continues to expand, setting up medical offices and growing like topsy throughout the Bronx, all run by its staff. These ever-expanding medical complexes are a disturbing new trend throughout our country and are adversely affecting private practice doctors and the communities they serve.

In Monte's most recent and ongoing expansion is a proposed eleven story building in a residential part of the Bronx that would bring in 1,000 patients per day to a community already burdened with woefully inadequate resources - including street parking. This proposed expansion has drawn sharp criticism and outright hostility from local residents. Fortunately, the hospital - which, in its defense, has been responsive to the community's concerns - is now talking about a much more scaled down version of the facility.

The reason for my trip to the hospital was an indescribable pain in the back of my leg close to my hamstring, which made it nearly impossible to walk. Upon my arrival at the ER, I was signed in and my blood pressure and other vitals were taken. My BP had reached 199/101, an unfamiliar and frightening number to me. It was a quiet holiday morning with few people waiting to be admitted, yet I still sat for almost an hour before two hospital employees grabbed me and steered me into the ER - a trip during which I nearly fell in staggering pain - and placed me on a bed. I then proceeded to lie there for nine hours, moaning and groaning, as I watched the hustle and bustle that can only be seen in an ER.

Patients came and went throughout the day, with some being admitted to the hospital and others sent home after being seen by the ER staff. This was triage - battlefield medicine where decisions had to be made in an instant - except, of course, in my case. After several hours, the one attending doctor present came over to me and, after a few words, ordered Percocet - an addictive drug containing codeine - for me. Even so, by that point I couldn't have cared less. Other staff was minimal on this holiday, but every bed was taken with some 30 people in need of care. Most had issues that a primary care doctor could have attended to - if these folks had insurance - but because so many still don't, ER's continue to be used as a neighborhood drop-in healthcare resource of convenience, even though convenience doesn't come cheap - my co-pay alone came to $65, plus the $20 cab ride.

There was one lone Physician's Assistant talking with each patient, moving as if on roller skates at amazing speed, stopping just long enough at each bed to make a snap judgment about care or medication. Oddly, there was no attempt to address my dangerously elevated BP. By 4:30pm, the Percocet still hadn't helped and I was admitted to the hospital. My bed and I sailed through the hallways and onto an elevator, finally reaching room K 631, joining the thirty-one other patients already on the floor. Then, at 11:30pm on Christmas Eve, I was wheeled flat on my back through more endless hallways and onto an elevator with corrugated metal flooring and taken to a lower level for an MRI of my back.

The next day, a few specialists appeared in my room, such as a neurologist and a Resident in neurosurgery. Both did some examining and spoke of the results of the MRI, which showed severe stenosis - a narrowing of the spinal canal, which could cause nerves to be irritated and pain. In addition, they noted that there was a two-inch mass located below my back in my pelvis. However, what neither doctor told me at the time is that it was located on an ovary and was as yet unclassified - benign? malignant? The neurologist recommended that additional images be taken, along with physical therapy and acupuncture, which seemed like inappropriate treatments for this as yet unidentified mass, which was my primary concern. And what was causing the pain? No one seemed to have that answer. Instead, the young Resident concluded that "...there is nothing here for us," and he recommended I schedule an appointment in two weeks with the Director of Neurosurgery, Dr. John Houten, whom I had asked the Physician's Assistant, Andrea Kazlas, to call. The Resident, however, never showed the MRI report or images to Dr. Houten.

Meanwhile, my Primary Care Physician ("PCP") no longer has admitting privileges at Monte, so she sent another PCP to take care of me. I can tell you, it does not work for a doctor you have known perhaps for years to send an unknown doctor to care for you in such a situation. Here is a tip folks: do not go to any hospital in which your PCP does not have admitting privileges. How are they supposed to coordinate your care in the hospital and see and examine you? This substitute doctor - who didn't know me from Eve - had no problem marching in on the first day at 6:00pm and doing nothing more than doubling my dosage of Percocet, and then on the second visit not showing up until 9:30pm after I had sat all day in terrible pain. He had absolutely no attachment or sense of responsibility to me, nor did he call my regular PCP and give her updates or report my test results to her. The higher dose of Percocet still failed to relieve the pain, so he then ordered Ibuprofen, Motrin and then Tylenol - none of which had any effect, either. Then, on Friday, he ordered a pain patch for me, which also failed to offer any relief.

By Friday afternoon, I was beginning to think about the mounting bills coming with each test and the sound of the "cha-ching!" of Monte's cash register while my pain continued undiminished. I had already refused a blood test to establish my blood-clotting factor - along with a medication to avoid blood clots - while in an inactive physical state. Why? Because I had been trying for three days to get a simple baby aspirin - which costs pennies - to address that very issue, yet no one responded. Why give me something cheap that has worked for me for years when they can give me something expensive that they can charge for? It even eluded staff that I was taking my own blood pressure medication that I had brought with me, which also cost pennies. On the second day I was there, when a staff member announced that I would receive the same medication at 10am that I had already taken earlier that morning, I responded, "I have already taken my pill at 6am, my usual time." Another tick on the bill avoided.

The "highlight" of every day was the awful, tasteless, unimaginative meals they served, accompanied by even worse decaf coffee. Fortunately, each meal was delivered by a nice, cheerful young man named Jason. The menus on every tray even had your name and room number, a nice personal touch. Come Friday, I was still in the same clothes I had been wearing the day I arrived, and the staff made no issue of me finally changing into a hospital gown. By then I also very much wanted a shower, and so dear, sweet Ms. Parnell - a nurse's aide technician - linked her arm under mine and we walked to the shower down the long hall, with her toting along a fresh, clean gown and toiletries. She gently placed me on a chair under the water and stood there getting soaked while she scrubbed my back and legs with no complaints - oh, how wonderful that shower was, the best of my life.

And so Friday night passed into Saturday, and another pain patch with double the dose was stuck to my arm as the fill-in PCP finally did something I could appreciate, bringing me a sesame bagel with a schmear of cream cheese and a really good cup of coffee from outside. As a New Yorker, I had finally arrived at a very happy place. That buffered me for the two sonograms on my pelvis that followed that afternoon, along with the three hours I waited on a bed outside the procedure room. By then it was 4:30pm - again, I had to wonder if they were stalling to keep me yet another night? After all, who would be there on a Saturday night to discuss the results with me? Perhaps I would even be held over until Monday? These stall tactics are part-and-parcel of hospital care, I've been told. No hospital wants empty beds.

The amazing wheels at Montefiore finally did go into full gear when they sent a terrific social worker named Jerry to see me and their in-house Medicaid office became available to me - as well as a home health aide, if needed. They provided a wealth of information on how I could access the critical help this safety program offers. Monte is truly a one-stop healthcare shop, even bringing in the director of customer service Leslie Bank who promised to check up on me while I am in surgery. Then, within days of leaving the hospital, I was set up with an appointment with an extraordinary gynecologic oncologist named Dr. Nicole Nevadunsky - young and out of Harvard,The Dana-Farber Cancer Institute and Brigham and Women's Hospital in Boston. I have met with her twice in the past two weeks, and she has been remarkably direct and very giving of her time and information.

I have asked for robotic surgery, a less invasive technique that Dr. Nevadunsky can do. In order to finally diagnose the mass, it must be removed with my ovary and Fallopian tube and a biopsy done during surgery. If it is cancerous, the biopsy will define the stage. Cancer diagnosis, treatment and prevention has come so far - and yet still not far enough. Increasing funding for the National Institutes of Health could address these imperatives, while also finding new treatments and cures for a host of other diseases. Even the CA-125 blood test that is a marker for ovarian cancer can produce false positives. Dr. Nevadunsky told me that 60% of these masses are benign, so we really need to cut down on these stressful, costly surgeries. The other day the surgeon and I agreed to go ahead with surgery, which will take place soon. I pray it isn't cancer, for if it is, it will involve removing twelve nodes and a piece of my stomach and a long road of chemo and/or radiation ahead - I definitely like that 60% number better.

During the informed consent discussion we had in her office, Dr. Nevadunsky was quite clear about the eight possible risks of the surgery that in no place appeared in such detail on the informed consent form. Those risks include infection, blood loss and damage to certain organs. She did, at that moment, what doctors in general do not - even though they absolutely must - and that is to detail the risks at least a week before a surgery or other invasive procedure, and not shove a form in your hand while you are going into the operating room while being told you are simply signing permission for surgery. I championed that such a provision be included in theInformed Consent bill S 1424-2015 that was written and introduced in Albany recently by Democratic New York State Senator Gustavo Rivera. This bill must be passed, despite the tough sledding it will face with a Conservative Republican majority ruling the State Senate.

As for the Montefiore staff, I can't praise them enough, especially the nurses like Ms. Anderson and Mr. Lindos, and the P.A.'s like Andrea Kazlas and Claudia Chang and so many others. Monte has been using P.A.'s for seven years now, and this is a harbinger of things to come as they are outstanding can deliver many of a doctor's duties while requiring less time and money to train. The doctor shortage will only increase as doctors must continue to deal with the prohibitive costs and difficulty of dealing with a corporatized medical system in which the insurance-industrial complex makes medical decisions based on their bottom line and not our health. I saw only three Residents in almost four days while I was at Monte, and no attending staff doctors, which raises the question: with close to ten million enrolling in healthcare under Obamacare last year to go along with the ten million expected this year, how will this patchwork system of healthcare be kept together by this dwindling number of extraordinarily dedicated professionals?

When I left the hospital in a wheelchair and was taken out to the street for a cab, I left with P.A. Claudia Chang, who had just finished a thirteen hour shift and was heading home. My journey, however, is just beginning, and I remain committed to seeing in my lifetime passage of H.R.676, an Improved And Expanded Medicare For All. No one should be in a hospital - ill or in pain - having to also think about how they will pay their hospital bills. How can that possibly lead to healing?

The Arizona Supreme Court reinstated a lawsuit on Wednesday that could strip health care away from 300,000 low-income Arizonians should it ultimately prevail. Though it should be noted that Wednesday’s decision dealt entirely with a procedural issue, that the court explicitly stated that its decision was not a “determination on the merits,” and that Arizona has a strong legal argument it can raise against this attempt to take health care away from many of the state’s most vulnerable residents.

Arizona Gov. Jan Brewer is one of a handful of Republican governors who supported expanding Medicaid under the Affordable Care Act. For the first three years of this expansion, the federal government will pay for the entire cost of the expansion. Beginning in 2017, however, states that accept the expansion must cover 10 percent of this cost. The bill Brewer signed expanding Medicaid in her state assesses fees on hospitals “for the purpose of funding the nonfederal share of the costs.” Nevertheless, the state’s hospitals support the Medicaid expansion, citing the fact that it rescues them from having toprovide uncompensated care to low-income patients.

Although a majority of both houses of Arizona’s legislature also supported the Medicaid expansion, significant minorities did not. This could matter because a provision of the state constitution states that most laws that provide “for a net increase in state revenues” require a two-thirds supermajority in both houses in order to become law. Wednesday’s decision by the state supreme court held that a bloc of lawmakers, that would have been large enough to kill the Medicaid expansion bill if this constitutional provision applied to it, has the legal right to bring a lawsuit challenging the hospital assessments that fund Arizona’s share of the expansion.

That, however, is all that Wednesday’s order held. It did not consider whether the two-thirds supermajority requirement actually applies to the Medicaid expansion law.

When the courts do consider the merits of this issue, Arizona has a strong legal argument supporting the Medicaid expansion. The state constitution also contains an exception to the supermajority requirement that applies to “[f]ees and assessments that are authorized by statute, but are not prescribed by formula, amount or limit, and are set by a state officer or agency.” The Medicaid expansion law appears carefully designed to fit within this exception, as it delegates the power to “establish, administer and collect” the assessment to the director of the state’s Medicaid agency, and it also gives this director the power to “adopt rules regarding the method for determining the assessment, the amount or rate of the assessment, and modifications or exemptions from the assessment.”

In their original complaint challenging the Medicaid expansion, the plaintiffs claim that this level of delegation to an executive branch official is itself unconstitutional, arguing that the Medicaid expansion law “impermissibily delegates the taxing power” to a state official “empowering him to set the amount of the tax and to determine who will be exempt.” Yet, whatever the merits of this argument might have been in the absence of the constitutional provisions defining the scope of the two-thirds supermajority requirement, the argument is much harder to sustain in the face of these provisions. The Arizona constitution explicitly contemplates that “[f]ees and assessments that are authorized by statute, but are not prescribed by formula, amount or limit, and are set by a state officer or agency” shall exist. And the Medicaid expansion law authorizes just such an assessment.

Nevertheless, should this lawsuit ultimately prevail, the likely result will be that hundreds of thousands of Arizonians will lose their health care, in order to spite a hospital assessment that the hospitals themselves support.

Democrats blew it on Obamacare. That’s according to retiring Iowa Senator Tom Harkin, who told The Hill today that he regrets that his party didn’t go far enough back in 2009 and 2010 when it was trying to push the Affordable Care Act through Congress

Pointing out the massive filibuster-proof majorities that Democrats had in the House and the Senate during that time, Harkin said about Obamacare that, “All the prevention stuff is good but it’s just really complicated. It doesn’t have to be that complicated…. [We should have enacted] single-payer right from the get go or at least put a public option would have simplified a lot. We had the votes to do that and we blew it.”

Harkin is right, and not just about how Democrats probably had the votes to pass truly progressive healthcare reform.

That’s because for all the very good things Obamacare does - things like expanding Medicaid access to the working poor and requiring insurance companies to accept people with pre-existing conditions - Obamacare still doesn’t go far enough. The biggest flaw in Obamacare, of course, is that it is centered around for-profit insurance companies.

Now, there’s nothing wrong with a doctor or a drug company making a profit off a job well-done or a life-saving medicine, but there’s absolutely no reason why anyone in the private sector should get rich off paying - or refusing to pay - medical bills, which, ultimately, is all insurance companies really do. They're just fancy banks. The fact that insurance companies do get rich off allowing or denying health care payments, though, is at the core of what’s wrong with our healthcare system. It’s the reason why we spend so much more on healthcare than any other developed country in the world, and it’s the reason why people continue to get screwed over by their insurance companies despite the new protections in Obamacare.

Take Malcolm MacDougall, for example. In a piece published in The Daily Beast just days before he died of cancer, MacDougall wrote about how his health insurance company, Health Republic/MagnaCare, refused time and time again to pay for his treatment, even though he always paid his premiums and made sure that all of his specialists were covered under Health Republic/MagnaCare.

This type of horror story still happens every day America, and it will continue to happen even with Obamacare as long as the profit motive remains at the core of our healthcare system. That’s why Tom Harkin’s comments about Democrats “blowing it” on healthcare reform ring so true.

If Democrats had gone ahead and pushed for real reform - aka a single-payer component, even if it was just a public option - no one would ever have to worry about dealing with a greedy for-profit health insurance company ever again. Instead, we’d be like Canada, which puts people over profits with its world-class single-payer healthcare system.

Oh, and in case you’re one of those people who’s scared of “socialism,” consider this: we’ve had single-payer healthcare here in the U.S. since the 1960s. It’s called Medicare, it’s never missed a check, and is doing just fine, thank you very much.

If Congress just lowered the Medicare eligibility age to 0 so all Americans, not just seniors, were in the program, then voila, we’d have single-payer health insurance for everyone right here in the United States. Every year, Congressman John Conyers introduces legislation to do just that, and has been for years.

Unfortunately, Republicans refuse to let Congress actually do its job, which is why in this era of the Caucus Room conspiracy, our healthcare system getting really and truly fixed is about as likely as Sarah Palin teaching college geography. But there is hope, and, ironically, it’s thanks to Obamacare.

Starting in 2017, Vermont, one of my home states, will begin offering all its residents single-payer coverage through a program called Green Mountain Healthcare. The brainchild of Governor Peter Shumlin, this program owes its existence to a special part of Obamacare that allows states to experiment with any type of healthcare system they want after 2016 as long as it meets the basic standards put into place by the Affordable Care Act.

My guess is that as soon as Vermont’s system gets up and running, other states will realize what a good deal it is and follow suit with their own single-payer programs. This, after all, is exactly what happened in Canada after Saskatchewan became the first province in that country to pass single-payer healthcare.

Democrats may have wasted an opportunity to pass truly progressive national healthcare reform back in 2009 and 2010, but thanks to Obamacare and progressives in Vermont, they’ll get another crack at it at the state level in just a few years. Let’s just hope they don’t get bushwacked by the Republicans on that opportunity.